Provider Demographics
NPI:1326359316
Name:BROOKS, DANIEL RAY (CPED)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RAY
Last Name:BROOKS
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6052 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9212
Mailing Address - Country:US
Mailing Address - Phone:918-488-0400
Mailing Address - Fax:918-488-8282
Practice Address - Street 1:6052 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9212
Practice Address - Country:US
Practice Address - Phone:918-488-0400
Practice Address - Fax:918-488-8282
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPED122224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCPED3358OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS & PEDORTHICS